RESUMO
Spinal glioblastoma multiforme (GBM) is uncommon, and its diagnosis may be challenging. This is especially true in the elderly population. Best management strategy remains to be defined. The purpose of this report is to document this rare condition, increase awareness (as a potential differential diagnosis) and propose treatment options in the elderly; a review of the relevant literature is included. A biopsy may be beneficial in given circumstances as cervical spinal GBM carries a better prognosis compared with intramedullary metastasis.
Assuntos
Vértebras Cervicais , Glioblastoma/diagnóstico , Neoplasias da Medula Espinal/diagnóstico , Idoso , Diagnóstico Diferencial , Glioblastoma/complicações , Glioblastoma/diagnóstico por imagem , Glioblastoma/cirurgia , Humanos , Imageamento por Ressonância Magnética , Masculino , Debilidade Muscular/etiologia , Neoplasias da Medula Espinal/complicações , Neoplasias da Medula Espinal/diagnóstico por imagem , Neoplasias da Medula Espinal/cirurgiaRESUMO
BACKGROUND: The surgical management of cervical brachialgia utilising anterior cervical discectomy and fusion (ACDF) or posterior cervical foraminotomy (PCF) is a controversial area in spinal surgery. Previous studies are limited by utilisation of non-validated outcome measures and, importantly, absence of pre-operative analysis to ensure both groups are matched. The authors aimed to compare the effectiveness of ACDF and PCF using validated outcome measures. To our knowledge, it is the first study in the literature to do this. METHODS: The authors conducted a 5-year retrospective review (2008-2013) of outcomes following both the above procedures and also compared the effectiveness of both techniques. Patients with myelopathy and large central discs were excluded. The main outcome variables measured were the neck disability index (NDI) and visual analogue scores (VAS) for neck and arm pain pre-operatively and again at 2-year follow-up. The Wilcoxon signed-rank test and Student t-tests were used to test differences. RESULTS: A total of 150 ACDFs and 51 PCFs were performed for brachialgia. There was no differences in the pre-operative NDI, VAS neck and arm scores between both groups (p > 0.05). As expected, both ACDF and PCF delivered statistically significant improvement in NDI, VAS-neck and VAS-arm scores. The degree of improvement of NDI, VAS-neck and VAS-arm were the same between both groups of patients (p > 0.05) with a trend favouring the PCF group. In the ACDF group, two (1.3 %) patients needed repeat ACDF due to adjacent segment disease. One patient (0.7 %) needed further decompression via a foraminotomy. In the PCF group one (2.0 %) patient needed ACDF due to persistent brachialgia. CONCLUSIONS: We found both interventions delivered similar improvements in the VAS and NDI scores in patients. Both techniques may be appropriately utilised when treating a patient with cervical brachialgia.
Assuntos
Descompressão Cirúrgica/efeitos adversos , Discotomia/efeitos adversos , Foraminotomia/efeitos adversos , Radiculopatia/cirurgia , Fusão Vertebral/efeitos adversos , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Centro Cirúrgico Hospitalar/estatística & dados numéricos , Reino UnidoRESUMO
We report a 20-year-old woman with a diagnosis of spinal neuroschistosomiasis that was confirmed histologically. Magnetic resonance imaging demonstrated an expanded, oedematous conus with intrinsic heterogeneous enhancement, which was initially thought to be a neoplastic lesion. This case demonstrates an alternative diagnosis to oncological lesions of the spinal cord which should be considered in patients who have recently travelled to endemic areas.
Assuntos
Neuroesquistossomose/diagnóstico , Doenças da Medula Espinal/diagnóstico , Adulto , Feminino , Humanos , Gravidez , Adulto JovemRESUMO
INTRODUCTION: There are many indications for cranioplasty with an increasing incidence partly attributable to an increase in decompressive craniectomy following trauma and stroke. The aim of this study was to compare the survival of acrylic and titanium cranioplasties used in our department. MATERIALS AND METHODS: Retrospective cohort study of 126 patients who underwent cranioplasty between 1997 and 2007. A comparison was made between those with acrylic (n = 61) and titanium (n = 65) cranioplasties. There was no significant difference in age and length of time between craniectomy and cranioplasty between the two groups. The indications for titanium cranioplasty tended to be classified as 'high risk' indications including trauma and stroke. A higher rate of pre-existing infection was noted in the acrylic group. Mean follow-up was 97.2 and 34 months for acrylic and titanium cranioplasties respectively. RESULTS: Mean survival (95% confidence intervals) was 135 months (134-153) and 92 months (82-102) for acrylic and cranioplasty respectively. Out of 13 failures, only two were associated with pre-existing infection. Overall cumulative survival was better for acrylic cranioplasty although this difference did not reach statistical significance. DISCUSSION: Although survival of acrylic cranioplasty appears to be better than titanium plates, there is no statistical significance. Acrylic has the advantage of being able to be applied at the time of surgery without any planning and does not cause artefact on future imaging. Titanium cranioplasty is strong, light-weight and inert and can be fashioned in the pre-operative setting.
Assuntos
Cimentos Ósseos/uso terapêutico , Craniotomia/efeitos adversos , Polimetil Metacrilato/uso terapêutico , Crânio/cirurgia , Titânio/uso terapêutico , Adulto , Humanos , Estimativa de Kaplan-Meier , Pessoa de Meia-Idade , Estudos Retrospectivos , Infecção da Ferida Cirúrgica/etiologia , Falha de TratamentoRESUMO
Controversy exists regarding the timing and outcome of surgery for lumbar degenerative disease (LDD) associated with foot drop. In this work, we report the results of a retrospective observational study from our center. We had a sample size of 26 patients with a minimum follow-up of 6 months. Of the 26 patients, 88% improved, with complete recovery observed in 61%. Thus, our data support the view that there is good recovery from operative management of foot drop secondary to LDD. Adjusting for preoperative strength, preoperative duration of weakness was a significant predictor of extent of recovery (odds ratio = 0.93; 95% confidence interval 0.88 to 0.98; p = 0.019). The model explained 50% of the variance in outcome in this study.
Assuntos
Vértebra Cervical Áxis/cirurgia , Atlas Cervical/cirurgia , Condrossarcoma/cirurgia , Cordoma/cirurgia , Fossa Craniana Posterior/cirurgia , Osteossarcoma/cirurgia , Equipe de Assistência ao Paciente , Neoplasias da Base do Crânio/cirurgia , Neoplasias da Coluna Vertebral/cirurgia , Adulto , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Transplante Ósseo , Quimioterapia Adjuvante , Condrossarcoma/radioterapia , Condrossarcoma/secundário , Cordoma/radioterapia , Terapia Combinada , Etoposídeo/administração & dosagem , Evolução Fatal , Feminino , Neoplasias Femorais/tratamento farmacológico , Neoplasias Femorais/patologia , Neoplasias Femorais/radioterapia , Neoplasias Femorais/cirurgia , Humanos , Ifosfamida/administração & dosagem , Comunicação Interdisciplinar , Fixadores Internos , Neoplasias Pulmonares/tratamento farmacológico , Neoplasias Pulmonares/secundário , Neoplasias Pulmonares/cirurgia , Masculino , Metotrexato/administração & dosagem , Pessoa de Meia-Idade , Terapia Neoadjuvante , Recidiva Local de Neoplasia , Osteossarcoma/tratamento farmacológico , Osteossarcoma/secundário , Cuidados Paliativos , Terapia com Prótons , Indução de Remissão , Neoplasias da Base do Crânio/radioterapia , Fusão Vertebral , Neoplasias da Coluna Vertebral/secundário , Retalhos CirúrgicosRESUMO
A case of pilocytic astrocytoma involving a spinal nerve root is reported. A 39-year-old woman presented with a 1-year history of progressive pain and numbness, predominantly in the S-1 dermatome. Magnetic resonance (MR) imaging revealed an intradural lesion at the tip of the conus medullaris. The intradural tumor was excised as was the sacrificed nerve root. Histological examination showed a pilocytic astrocytoma in which there were unusual features of calcification and ossification. At 3-year follow-up review MR imaging demonstrated no residual tumor. To the best of the authors' knowledge, this is the first case of a primary pilocytic astrocytoma, a tumor typically of central nervous system origin, arising from a spinal nerve root.